GPS Hot Work Permit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Indicate what this permit is being used for.

• Cutting

• Welding

• Grinding

• Drilling

• Date and Time Issued

  Date

• Date and Time Expired

  Date

• Hot Work Location.

• Task Description.

Emergency Numbers

• Fire:

• Ambulance:

• Plant Channel or Phone Number:

General

• Sprinklers or fire suppression system in service and operable.

  Yes

  No

  N/A

• Alternative fire protection (If permanent systems are out of service)

  Yes

  No

  N/A

• Describe:

• Fire hoses and other portable fire extinguishers are available

  Yes

  No

  N/A

• Welding flash screens in place to protect adjacent workers

  Yes

  No

  N/A

• Ventilation adequate to control airborne contaminates (I.e. Fumes)

  Yes

  No

  N/A

• Cutting or welding equipment in good condition

  Yes

  No

  N/A

Within 35 Feet or Work

• Floors swept clean of combustibles

  Yes

  No

  N/A

• Flammable liquids and chemical containers are removed

  Yes

  No

  N/A

• All combustibles removed or covered with fire resistant tarps, metal shields or other appropriate means

  Yes

  No

  N/A

• All wall and floor openings covered (i.e. ducts, pipes, conveyors, ect)

  Yes

  No

  N/A

• Fire resistant tarps suspended beneath work

  Yes

  No

  N/A

• Flammable / Explosive atmosphere eliminated (Check LEL with gas meter every hour)

  Yes

  No

  N/A

• NO WORK PERMITTED IF LEL IS 10% OR HIGHER!

• LEL %

• Select date

  Date

• LEL %

• Select date

  Date

• LEL %

• Select date

  Date

Work on Enclosed Equipment

• Equipment was emptied, cleaned, purged or otherwise safeguarded

  Yes

  No

  N/A

• Confined space procedures followed if entry is required

  Yes

  No

  N/A

Fire Watch

• Fire watch provided during 30 minutes after work, including breaks

  Yes

  No

  N/A

• Trained on proper use of fire fighting equipment and emergency notification

  Yes

  No

  N/A

• Periodically check area for ______ hours after post work observation period (30 minutes)

  Yes

  No

  N/A

• I verify that the hot work location has been inspected and all necessary precautions have been taken to remove fire hazards.

• Person authorizing permit:

  Sign

• Person performing hot work:

  Sign

• Designated fire watch:

  Sign

Final Check

• The work area and all the adjacent areas to which sparks and heat may have spread (including floors above and below and on opposites sides of the wall) were inspected after post work observation period and found free of fire sparks and hot spots.

• Person performing hot work:

  Sign

• Designated fire watch:

  Sign